浙孚 ZheJiang University Antianginal druas 抗心绞痛药物 Huifang Tang Department of pharmacology Zhejiang Universiti School of Medicin tanghuifang⊙z
Antianginal drugs 抗心绞痛药物 Huifang Tang Department of pharmacology Zhejiang University School of Medicine tanghuifang@zju.edu.cn
1. Overview 2. Antianginal drugs Organic nitrates β-b| ockers Calcium channel blockers 3. Combination of antianginal drugs
1. Overview 2. Antianginal drugs - Organic nitrates - β-blockers - Calcium channel blockers 3. Combination of antianginal drugs
Overview: Angina pectoris心绞痛 The name angina pectoris denotes chest pain caused by accumulation of metabolites resulting from myocardial ischemia 临床表现:阵发性的胸骨后压榨性疼痛并向左 上肢放射。 most common cause of angina is atheromatous obstruction of the large coronary vessels(coronary artery disease, CAD)
Overview: Angina pectoris 心绞痛 The name angina pectoris denotes chest pain caused by accumulation of metabolites resulting from myocardial ischemia. • 临床表现：阵发性的胸骨后压榨性疼痛并向左 上肢放射。 • most common cause of angina is atheromatous obstruction of the large coronary vessels (coronary artery disease, CAD). 3
Symptoms 16%7% 40% 4% 46% 23 Sudden, uncomfortable pressure, fullness squeezing or severe subsTernal pain, radiaTing to the left arm shoulders neck, etc
Sudden, uncomfortable pressure, fullness, squeezing or severe substernal pain, radiating to the left arm, shoulders, neck, etc. Symptoms:
Classification of angina pectoris Stable angina pectoris Unstable angina pectoris( Effort angina Caused initial onset type(初发型)( ( classic angina) atherosclerosis accelerated typer(恶化型 plaque and/or thrombus spontaneous type(自发型) formation angina at rest卧位型) Variant angina(变异型) Caused by spontaneous spasm of coronary arteries Mixed angina pectoris
• Stable angina pectoris • Unstable angina pectoris – initial onset type(初发型) – accelerated type(恶化型) – spontaneous type(自发型) • angina at rest(卧位型) • Variant angina （变异型） • Mixed angina pectoris Caused by atherosclerosis plaque and/or thrombus formation Caused by spontaneous spasm of coronary arteries Classification of angina pectoris: 5 Effort angina （classic angina）
表1加拿大心脏病学会的劳力型心绞痛分级标准(CCSC) 分级 特点 I级一般日常活动例如走路、登楼不引起心绞痛,心绞痛发生在剧烈、速度快或长时间 的体力活动或运动时 II级 日常活动轻度受限。心绞痛发生在快步行走、登楼、餐后行走、冷空气中行走、逆 风行走或情绪波动后活动 III 级 日常活动明显受限,心绞痛发生在平路一般速度行走时 ⅣV级 轻微活动即可诱发心绞痛,患者不能作任何体力活动,但休息时无心绞痛发作
Stable and unstable angina pectoris usually occur on following conditions y Extreme weather strong emotion Excessive exercise Excessive food intake Excessive smoking Variant angina: usually occur when a person is at rest between midnight and gan
Extreme weather Excessive food intake Excessive smoking Excessive exercise Strong emotion ➢ Variant angina: usually occur when a person is at rest between midnight and 8am ➢ Stable and unstable angina pectoris usually occur on following conditions 7
How does angina pectoris happen? Demand of the myocardium for oxygen 动脉粥样硬化斑块 normal 和血栓形成 Ischemia 冠脉痉挛 Oxygen delivery to the myocardium by the coronary circulation
Demand of the myocardium for oxygen Oxygen delivery to the myocardium by the coronary circulation Normal Ischemia How does angina pectoris happen? 8 动脉粥样硬化斑块 和血栓形成 冠脉痉挛
Factors disturb the balance between oxygen demand and delivery Demand v Preload (venous return Y Afterload (arteriolar resistance) Heart rate D elIve Atherosclerosis plaque Thrombus Y Spasm of coronary arteries
Demand ✓ Preload (venous return ) ✓ Afterload (arteriolar resistance) ✓ Heart rate Delivery ✓ Atherosclerosis plaque ✓ Thrombus ✓ Spasm of coronary arteries 9 Factors disturb the balance between oxygen demand and delivery
Contractile AV State Oxygen Difference OXYGEN OXYGEN Heart DEMAND SUPPLY Regional Rate Myocardial ≠ Distribution Wall Coronary Tension Blood ISCHEMIA Flow Ventricular Coronar Aortic Pressure Volume Vascular Resistance Pressure 影响心肌耗氧量及供氧量的因素
影响心肌耗氧量及供氧量的因素
